Provider Demographics
NPI:1306428677
Name:CREATIVE BOUNDARIES LLC
Entity type:Organization
Organization Name:CREATIVE BOUNDARIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZEVA
Authorized Official - Middle Name:
Authorized Official - Last Name:CITRONENBAIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-646-3164
Mailing Address - Street 1:PO BOX 676
Mailing Address - Street 2:
Mailing Address - City:TALLMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10982-0676
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 JAY CT
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1627
Practice Address - Country:US
Practice Address - Phone:914-646-3164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty